Skip to main content
Top
Gepubliceerd in: Netherlands Heart Journal 12/2011

01-12-2011 | Original article

Clinical worsening after pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension

Auteurs: B. Schölzel, R. Snijder, W. Morshuis, N. Saouti, T. Plokker, M. Post

Gepubliceerd in: Netherlands Heart Journal | Uitgave 12/2011

Log in om toegang te krijgen
share
DELEN

Deel dit onderdeel of sectie (kopieer de link)

  • Optie A:
    Klik op de rechtermuisknop op de link en selecteer de optie “linkadres kopiëren”
  • Optie B:
    Deel de link per e-mail

Abstract

Introduction

Pulmonary endarterectomy (PEA) is the most effective treatment for chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study is to evaluate long-term survival and freedom from clinical worsening after PEA.

Methods

All patients who underwent PEA in our hospital between May 2000 and August 2009 were included. Follow-up parameters were all-cause mortality and time to clinical worsening, defined as a combination of death, need for pulmonary hypertension-specific medication or 15% decrease in six-minute walk distance without improvement in functional class. The Cox proportional hazard regression was used to identify predictors.

Results

Seventy-four consecutive patients (mean age 55.9 ± 13.8 years, 51% female) underwent PEA. Prior to surgery, 55 patients were in NYHA functional class III or higher. The mean pulmonary artery pressure was 41.3 ± 11.9 mmHg with a mean pulmonary vascular resistance of 521 ± 264 dyn·s·cm−5 (range 279–1331 dyn·s·cm−5). Five patients (6.8%) died in-hospital. Out of hospital, 5 out of 69 patients (7.2%) died during a median follow-up of 3.7 ± 2.2 years [range 0.1–8.5 years]). The one- and five-year survival rates were 93% and 89%, respectively. During follow-up, clinical worsening occurred in 13 out of 69 patients (18.8%). The one- and five-year rates of freedom from clinical worsening were 94% and 72%, respectively. The baseline NT-pro BNP level tended to be a predictor for occurrence of clinical worsening.

Conclusion

Pulmonary endarterectomy is associated with good long-term survival in patients with CTEPH. However, clinical worsening occurred in a substantial number of patients at long-term follow-up.
Literatuur
1.
go back to reference Becattini C, Agnelli G, Pesavento R, et al. Incidence of chronic thromboembolic pulmonary hypertension after a first episode of pulmonary embolism. Chest. 2006;130:172–5.PubMedCrossRef Becattini C, Agnelli G, Pesavento R, et al. Incidence of chronic thromboembolic pulmonary hypertension after a first episode of pulmonary embolism. Chest. 2006;130:172–5.PubMedCrossRef
2.
go back to reference Pengo V, Lensing AW, Prins MH, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med. 2004;350:2257–64.PubMedCrossRef Pengo V, Lensing AW, Prins MH, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med. 2004;350:2257–64.PubMedCrossRef
3.
go back to reference Klepetko W, Mayer E, Sandoval J, et al. Interventional and surgical modalities of treatment for pulmonary arterial hypertension. J Am Coll Cardiol. 2004;43:73S–80.PubMedCrossRef Klepetko W, Mayer E, Sandoval J, et al. Interventional and surgical modalities of treatment for pulmonary arterial hypertension. J Am Coll Cardiol. 2004;43:73S–80.PubMedCrossRef
4.
go back to reference Hoeper MM, Mayer E, Simonneau G, Rubin LJ. Chronic thromboembolic pulmonary hypertension. Circulation. 2006;113:2011–20.PubMedCrossRef Hoeper MM, Mayer E, Simonneau G, Rubin LJ. Chronic thromboembolic pulmonary hypertension. Circulation. 2006;113:2011–20.PubMedCrossRef
5.
go back to reference Jamieson SW, Kapelanski DP, Sakakibara N, et al. Pulmonary endarterectomy: experience and lessons learned in 1500 cases. Ann Thorac Surg. 2003;76:1457–62.PubMedCrossRef Jamieson SW, Kapelanski DP, Sakakibara N, et al. Pulmonary endarterectomy: experience and lessons learned in 1500 cases. Ann Thorac Surg. 2003;76:1457–62.PubMedCrossRef
6.
go back to reference Saouti N, Morshuis WJ, Heijmen RH, Snijder RJ. Long-term outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: a single institution experience. Eur J Cardiothorac Surg. 2009;35:947–52.PubMedCrossRef Saouti N, Morshuis WJ, Heijmen RH, Snijder RJ. Long-term outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: a single institution experience. Eur J Cardiothorac Surg. 2009;35:947–52.PubMedCrossRef
7.
go back to reference Condliffe R, Kiely DG, Gibbs JS, et al. Improved outcomes in medically and surgically treated chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med. 2008;177:1122–7.PubMedCrossRef Condliffe R, Kiely DG, Gibbs JS, et al. Improved outcomes in medically and surgically treated chronic thromboembolic pulmonary hypertension. Am J Respir Crit Care Med. 2008;177:1122–7.PubMedCrossRef
8.
go back to reference Kim NH. Assessment of operability in chronic thromboembolic pulmonary hypertension. Proc Am Thorac Soc. 2006;3:584–8.PubMedCrossRef Kim NH. Assessment of operability in chronic thromboembolic pulmonary hypertension. Proc Am Thorac Soc. 2006;3:584–8.PubMedCrossRef
9.
go back to reference Masuda M, Nakajima N. Our experience of surgical treatment for chronic pulmonary thromboembolism. Ann Thorac Cardiovasc Surg. 2001;7:261–5.PubMed Masuda M, Nakajima N. Our experience of surgical treatment for chronic pulmonary thromboembolism. Ann Thorac Cardiovasc Surg. 2001;7:261–5.PubMed
10.
go back to reference Daily PO, Dembitsky WP, Iversen S. Technique of pulmonary thromboendarterectomy for chronic pulmonary embolism. J Card Surg. 1989;4:10–24.PubMedCrossRef Daily PO, Dembitsky WP, Iversen S. Technique of pulmonary thromboendarterectomy for chronic pulmonary embolism. J Card Surg. 1989;4:10–24.PubMedCrossRef
11.
12.
go back to reference Matsuda H, Ogino H, Minatoya K, et al. Long-term recovery of exercise ability after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Ann Thorac Surg. 2006;82:1338–43.PubMedCrossRef Matsuda H, Ogino H, Minatoya K, et al. Long-term recovery of exercise ability after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Ann Thorac Surg. 2006;82:1338–43.PubMedCrossRef
13.
go back to reference Freed DH, Thomson BM, Berman M, et al. Survival after pulmonary thromboendarterectomy: Effect of residual pulmonary hypertension. J Thorac Cardiovasc Surg. 2010 May 12. [Epub ahead of print]. Freed DH, Thomson BM, Berman M, et al. Survival after pulmonary thromboendarterectomy: Effect of residual pulmonary hypertension. J Thorac Cardiovasc Surg. 2010 May 12. [Epub ahead of print].
14.
go back to reference Bonderman D, Skoro-Sajer N, Jakowitsch J, et al. Predictors of outcome in chronic thromboembolic pulmonary hypertension. Circulation. 2007;115:2153–8.PubMedCrossRef Bonderman D, Skoro-Sajer N, Jakowitsch J, et al. Predictors of outcome in chronic thromboembolic pulmonary hypertension. Circulation. 2007;115:2153–8.PubMedCrossRef
15.
go back to reference Auger WR, Kerr KM, Kim NH, Ben-Yehuda O, Knowlton KU, Fedullo PF. Chronic thromboembolic pulmonary hypertension. Cardiol Clin. 2004;22:453–66. vii.PubMedCrossRef Auger WR, Kerr KM, Kim NH, Ben-Yehuda O, Knowlton KU, Fedullo PF. Chronic thromboembolic pulmonary hypertension. Cardiol Clin. 2004;22:453–66. vii.PubMedCrossRef
16.
go back to reference Kim NH, Fesler P, Channick RN, et al. Preoperative partitioning of pulmonary vascular resistance correlates with early outcome after thromboendarterectomy for chronic thromboembolic pulmonary hypertension. Circulation. 2004;109:18–22.PubMedCrossRef Kim NH, Fesler P, Channick RN, et al. Preoperative partitioning of pulmonary vascular resistance correlates with early outcome after thromboendarterectomy for chronic thromboembolic pulmonary hypertension. Circulation. 2004;109:18–22.PubMedCrossRef
17.
go back to reference Galiè N, Kim NH. Pulmonary microvascular disease in chronic thromboembolic pulmonary hypertension. Proc Am Thorac Soc. 2006;3:571–6.PubMedCrossRef Galiè N, Kim NH. Pulmonary microvascular disease in chronic thromboembolic pulmonary hypertension. Proc Am Thorac Soc. 2006;3:571–6.PubMedCrossRef
18.
go back to reference Dartevelle P, Fadel E, Mussot S, et al. Chronic thromboembolic pulmonary hypertension. Eur Respir J. 2004;23:637–48.PubMedCrossRef Dartevelle P, Fadel E, Mussot S, et al. Chronic thromboembolic pulmonary hypertension. Eur Respir J. 2004;23:637–48.PubMedCrossRef
19.
go back to reference Kim NH. Assessment of operability in chronic thromboembolic pulmonary hypertension. Proc Am Thorac Soc. 2006;3:584–8.PubMedCrossRef Kim NH. Assessment of operability in chronic thromboembolic pulmonary hypertension. Proc Am Thorac Soc. 2006;3:584–8.PubMedCrossRef
20.
go back to reference Freed DH, Thomson BM, Tsui SS, et al. Functional and haemodynamic outcome 1 year after pulmonary thromboendarterectomy. Eur J Cardiothorac Surg. 2008;34:525–9.PubMedCrossRef Freed DH, Thomson BM, Tsui SS, et al. Functional and haemodynamic outcome 1 year after pulmonary thromboendarterectomy. Eur J Cardiothorac Surg. 2008;34:525–9.PubMedCrossRef
21.
go back to reference Reesink HJ, van der Plas MN, Verhey NE, van Steenwijk RP, Kloek JJ, Bresser P. Six-minute walk distance as parameter of functional outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. J Thorac Cardiovasc Surg. 2007;133:510–6.PubMedCrossRef Reesink HJ, van der Plas MN, Verhey NE, van Steenwijk RP, Kloek JJ, Bresser P. Six-minute walk distance as parameter of functional outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. J Thorac Cardiovasc Surg. 2007;133:510–6.PubMedCrossRef
22.
go back to reference Corsico AG, D'Armini AM, Cerveri I, et al. Long-term outcome after pulmonary endarterectomy. Am J Respir Crit Care Med. 2008;178:419–24.PubMedCrossRef Corsico AG, D'Armini AM, Cerveri I, et al. Long-term outcome after pulmonary endarterectomy. Am J Respir Crit Care Med. 2008;178:419–24.PubMedCrossRef
23.
go back to reference McLaughlin VV, Badesch DB, Delcroix M, et al. End points and clinical trial design in pulmonary arterial hypertension. J Am Coll Cardiol. 2009;54:S97–107.PubMedCrossRef McLaughlin VV, Badesch DB, Delcroix M, et al. End points and clinical trial design in pulmonary arterial hypertension. J Am Coll Cardiol. 2009;54:S97–107.PubMedCrossRef
Metagegevens
Titel
Clinical worsening after pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension
Auteurs
B. Schölzel
R. Snijder
W. Morshuis
N. Saouti
T. Plokker
M. Post
Publicatiedatum
01-12-2011
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Netherlands Heart Journal / Uitgave 12/2011
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-011-0203-4

Andere artikelen Uitgave 12/2011

Netherlands Heart Journal 12/2011 Naar de uitgave